Dr. Smith's ECG Blog

MAY 3, 2024

She was found by medics agitated, hypotensive, diaphoretic, and in shock. But this time the Queen gets it wrong (thinks it is not OMI): There were runs of VT: Tha patient arrived in profound shock and had an ED ECG: Now there is some evolution to include the ST elevation (rather than ST depression) in V4-V6.

Shock 127

Shock EKG/ECG Hospitals EMS 127

EMDocs

DECEMBER 1, 2024

Ischemic Hepatitis and Septic Shock Secondary to Murine Typhus Infection in Pregnancy. 2023 Oct 26;15(6):700-716. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. 2023 Oct 26;15(6):700-716. Berry M, Wang AM, Lahham RF, Zhang X, Pacheco LD. 2024 Jun 10;14(2):e185-e187. Blanton LS.

EMS 105

EMS Infectious Diseases Shock Airway Management 105

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). falciparum parasitemia , and no other defined cause of AMS (WHO 2023). falciparum parasitemia , and no other defined cause of AMS (WHO 2023).

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Abdominal pain may be absent in up to 60%.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

EMDocs

JANUARY 8, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline Updates for 2023 were just published. 2023 Dec 18. The post 2023 AHA Update on ACLS appeared first on emDOCs.net - Emergency Medicine Education. o C recommended (Level 1: strong). Circulation.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

Emergency Medicine Cases

JANUARY 2, 2024

Based on a blend of number of listens, feedback from listeners, website visits and personal faves, EM Cases Best of 2023 Top 10. The post EM Cases Best of 2023 Top 10 appeared first on Emergency Medicine Cases.

EMS 119

EMS Poisoning Shock 119

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

The VSR is what is causing the cardiogenic shock! Mechanical complications occur acutely and significantly alter hemodynamics leading to comp ensatory mechanism which usually involve vasoconstriction and tachycardia, both hallmarks of cardiogenic shock. PIRP is strongly associated with myocardial rupture.

Shock 109

Shock EKG/ECG Hospitals Wellness 109

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. The usefulness of administering methylene blue for refractory vasodilatory shock due to CCB poisoning is uncertain.

Poisoning 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

EMDocs

NOVEMBER 19, 2024

Published 2023. Accessed October 23, 2023. Accessed October 23, 2023. Accessed October 23, 2023. Accessed October 23, 2023. Accessed October 23, 2023. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report. Innov Clin Neurosci. Micromedex.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. He was admitted to the ICU and was unstable, in shock, overnight. Severely ill patients from any etiology can have very abnormal ECGs = My Comment by K EN G RAUER, MD ( 5/26 /2023 ): = There are more questions than answers in today's case.

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

RebelEM

FEBRUARY 24, 2025

13 That is to say nothing of the effect that the type and response to shock has on the individual patients involved in these studies. As seen in the Andromeda Shock Trial, and multiple other trials involving shocked patients, capillary return also reigns supreme regarding physical examination. Apr 2023; PMID: 37009935.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

RebelEM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. Hydroxocobalamin Versus Methylene Blue for the Treatment of Vasoplegic Shock Associated With Cardiopulmonary Bypass. 2023 Jul 19.

Shock 71

Shock Administration Academics Hospitals 71

Ken Grauer, MD

AUGUST 16, 2024

PEARL # 2: In the absence of associated heart failure ( cardiogenic shock ) — sinus tachycardia is not a common finding in acute MI. For now — Let's continue with ECG signs consistent with and suggestive of acute RV "Strain". Sinus Tachycardia and RAD — as already noted above.

EKG/ECG 380

EKG/ECG Wellness Shock 380

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

Taming the SRU

DECEMBER 17, 2024

Other contraindications include those who are unable to drink liquid (respiratory problems or impaired unconsciousness) and patients in shock, persistent vomiting, or with an ileus. Updated 2023 Oct 22]. References Castera MR, Borhade MB. Fluid Management. In: StatPearls [Internet].

Dehydration 84

Dehydration Fluid Resuscitation Resuscitation Administration 84

Pediatric EM Morsels

JUNE 2, 2023

Food Protein Induced Enterocolitis Syndrome (FPIES): Basics Non IgE-mediated food allergy ( Calvani, 2021 ) Profuse vomiting and diarrhea that can progress to lethargy , pallor , and shock Usually seen in infants (<1 year) as new foods are being introduced in diet Common dietary triggers include grains, cow milk and soy ( Michelet, 2017 ) Can also (..)

Dehydration 193

Dehydration Shock Pediatrics Emergency Department 193

EB Medicine

JANUARY 3, 2023

2) 2023 E/M coding guidelines are in effect. 2) 2023 E/M coding guidelines are in effect. Announcements: 1) The interactive Clinical Pathways have launched and they are available for free!

Shock 52

Shock Pediatrics Airway Management Sepsis 52

The Bottom Line

OCTOBER 28, 2023

Landiolol and Organ Failure in Patients With Septic Shock Whitehouse. JAMA Published online October 25, 2023. 2023.20134 Clinical Question In patients with tachycardia and septic shock who are treated with high dose norepinephrine does the use of β-blockade for up to 14 days reduce organ failure compared to standard care?

Shock 65

Shock Sepsis 65

EMDocs

NOVEMBER 13, 2024

Management: Patients can rapidly progress to septic shock and multiorgan failure. C (100° F), or if the ascitic fluid ANC is > 250 cells/mm 3 Mortality increases by 8-10% for every hour delay in antibiotics for patients with cirrhosis and septic shock. 2023 Aug;70:84-89. For antibiotics, utilize local antibiogram.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

EM Ottawa

APRIL 4, 2024

This is also represented in the amount of literature that has been published on the use of PoCUS in 2023. In this post, Dr. Murray reviews 5 articles (with case examples and videos), […] The post Probing 2023: PoCUS Articles to Change Your Practice appeared first on EMOttawa Blog.

Ultrasounds 73

Ultrasounds Infectious Diseases COPD Shock 73

Pediatric EM Morsels

JULY 21, 2023

Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier!

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. This is an ominous sign.

EKG/ECG 128

EKG/ECG Shock Emergency Department Ambulance Services 128

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

Board Bombs

APRIL 30, 2023

Lets talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. Lets talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. In fact, it might just decide to kill the patient if you do that. Want to experience the greatest in board studying? Episode 174.

Shock 52

Shock Sepsis 52

Board Bombs

APRIL 30, 2023

Let’s talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. Let’s talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. In fact, it might just decide to kill the patient if you do that. Want to experience the greatest in board studying? Episode 174.

Shock 52

Shock Sepsis 52

RebelEM

FEBRUARY 15, 2024

There has been no high level evidence to help guide practice until now…the Non-Invasive Airway Management of Comatose Poisoned Emergency Patients (NICO) trial. Paper: Freund Y et al. Effect of Noninvasive Airway management of Comatose Patients with Acute Poisoning: A Randomized Clinical Trial. References: Freund Y et al.

Poisoning 141

Poisoning Airway Management Seizures Shock 141

EMDocs

APRIL 6, 2024

. #1: Phoenix Criteria – New Pediatric Sepsis Score Spoon Feed The Phoenix Sepsis Score, which is a novel clinical criterion for pediatric sepsis and septic shock developed using measures of organ dysfunction, outperforms existing IPSCC criteria for the diagnosis of pediatric sepsis and septic shock. 2023-062755. 2024.0196. #2:

Sepsis 98

Sepsis Pediatrics Shock 98

Sensible Medicine

JUNE 24, 2024

One of the most common uses of LV assist devices is cardiogenic shock due to an acute MI. Between 2009-2023, many thousands, perhaps hundreds of thousands of patients, had Impella devices implanted. As I covered in April , the DANGER-Shock trial produced positive results. DANGER-Shock, like many trials, had caveats.

Shock 105

Shock Hospitals 105

PEMBlog

OCTOBER 18, 2023

Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). Neonatal toxic shock syndrome-like exanthematous disease (NTED).

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

EMDocs

JANUARY 13, 2024

2023 Nov 28:emermed-2023-213285. doi: 10.1136/emermed-2023-213285. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock.

Stroke 88

Stroke Shock Pediatrics Resuscitation 88

Don't Forget the Bubbles

MARCH 31, 2025

2023 Nov;7(1):e002094. doi: 10.1136/bmjpo-2023-002094. The primary outcome was to evaluate the impact of % FO in paediatric patients with sepsis or septic shock at any time after PICU admission. 41% of patients with septic shock had MODS. Emergency medicine updates: Management of sepsis and septic shock.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Procamio randomized trial. == MY Comment , by K EN G RAUER, MD ( 9/20 /2023 ): == Assessment of the regular WCT ( = W ide- C omplex T achycardia ) patient — is one of the most challenging problems in emergency medicine.

EKG/ECG 139

EKG/ECG Shock Academics Documentation/Coding 139

The Skeptics' Guide to EM

FEBRUARY 11, 2023

Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. Intervention: * Vector Change Defibrillation: Pads are placed in an anterior-posterior pad placement after standard anterior-anterior configuration following the third shock with standard defibrillation.

Shock 57

Shock CPR Hyperthermia / Hypothermia Hospitals 57

Ken Grauer, MD

OCTOBER 21, 2023

PEARL # 1: Although seeing an elevated Troponin would provide additional support for immediate cardiac catheterization — the clinical reality is that the initial Troponin reading will not always be elevated in patients with acute coronary occlusion ( See March 24, 2023 post in Dr. Smith's ECG Blog ).

EKG/ECG 248

EKG/ECG Shock Wellness 248

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104